Medical Doctor

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

33*****42

NOT RENEWED

N

MD

MUJEEB

U

SHAD

MUJEEB U SHAD MD

04/03/2013

04/03/2013

07/31/2014

SALEM

OR

97306

SANGAMON

PHARM DISTRIBUTOR

II III IV V

N

11/17/2014